Inside Health

PERSONAL HEALTH

PERSONAL HEALTH; Advice for Perplexed Parents of Late Talkers

By JANE E. BRODY

Published: June 8, 2004

Correction Appended

When your 18-month-old speaks fewer than 10 words, your 2-year-old uses no two-word combinations, or your 3-year-old's speech is unintelligible to anyone but the immediate family, should you worry? Is the child merely a slow talker who will eventually catch up to his or her peers, or does the child have a speech or language disorder in need of evaluation and therapy?

Every parent knows that children develop at different rates. There is a very wide range of normal.

At 22 months, my niece clearly enunciated complex sentences while at 30 months a boy I know was still uttering only two- or three-word phrases. Like most children, they both developed to have perfectly normal verbal and social ability.

The availability of free or low-cost speech therapy for preschoolers under the federal Individuals With Disabilities Education Act has prompted some parents to seek such therapy for children with articulation difficulties or seemingly slow speech development that are well within the range of normal for their age. This can be unnecessarily stressful for parents and children and a waste of valuable resources.

What's Normal?

My twin grandsons had just turned 2 when their parents decided to take a vacation without them. The boys, who were told that Mommy and Daddy were going to the beach, looked at their parents' wedding photograph each day they were gone and said, ''Mommy, Daddy, bitch.'' We laughed at the mispronunciation, but it was clear that the boys got the message and could voice their understanding.

Now, from reading ''The Late Talker: What to Do if Your Child Isn't Talking Yet'' by Dr. Marilyn C. Agin, Lisa F. Geng and Malcolm J. Nicholl, it is also clear that the boys were well within normal range in their language development. Typically by age 2, children use a variety of two-word combinations (more cookie, mommy work), know at least 50 words and mostly use words to communicate.

Now that the boys are 4, I was reassured by the book that their difficulties pronouncing ''l'' and ''th'' and their frequent failure to string two consonants together (''geen'' for ''green'') is also within the range of normal.

As ''The Late Talker'' points out, it is not unusual for a child of 4 or 5 to mispronounce l, s, r, v, z, j, ch, sh and th. A 5- or 6-year-old who says ''tiziz'' for ''scissors'' does not have a speech or language disorder.

The authors note: ''All children misarticulate sounds in the course of normal speech development. They may use sound substitutions, like 'wady' for 'lady.' They may omit sounds, saying 'baw' instead of 'ball.' Or they may distort a sound, so that 'spaghetti' comes out as 'psketti.'''

The book continues, ''Concern arises when these errors continue beyond the time when a child normally outgrows them'' -- usually by 7 or 8.

But the authors caution that some parents of children with what they think are speech delays go overboard in trying to speed development. They write, ''Excessive parental concern can also impede the child's language development, and counseling may be needed for the parents.''

Real Problems

When children's ability to communicate lags way behind that of their peers, there may be reason for concern and a need to attend to the matter. Although Einstein reportedly did not talk until he was 3, parents should not belulled into a false sense of security that the genius within will emerge when the child is ready, experts say.

Studies have shown that without any intervention, half of children with delays in the ability to express language at age 2 catch up to their peers by 3, and that another 25 percent have normal speech when they start school. But ''this leaves 25 percent of late-talking children who do not grow out of their problem before starting school,'' the authors of ''The Late Talker'' note.

In such seriously speech-delayed children, intelligible speech may not appear on its own; these children often require professional help if they are to develop with normal social and academic skills.

Speech and language difficulties can have many causes, including an undetected hearing impairment, poor oral muscle tone or coordination or a neurological disorder like Asperger's syndrome, a mild form of autism, or apraxia, a breakdown in the transmission of messages from the brain to the muscles in the jaw, cheeks, lips, tongue and palate.

The parents of a bright man I know who said nothing, not even ''Mommy'' or ''Daddy,'' before age 3, were told by child development specialists in 1970 that their son was perfectly normal. Once he started talking, he spoke in full, complex sentences. But years later he received a diagnosis of Asperger's syndrome, which severely impairs his ability to relate to others.

The son of Mrs. Geng, an author of ''The Late Talker,'' also had delayed speech and other problems that turned out to be related. He could not blow out the candles on his second birthday cake because he was unable to purse his lips. Nor could he smile. Except for ''ma,'' he said nothing but ''mmm'' to indicate anything he wanted. Eventually, doctors told her that the boy had apraxia.

Too often, when parents express concern to the pediatrician or preschool teacher about what they believe are a child's speech and language problems, they are told to ''wait and see.'' That can result in the loss of precious time, during which the child might be receiving therapy.

Mrs. Geng is glad she did not wait until age 3, as suggested by the pediatrician, to have her son's speech and hearing evaluated and therapy begun. Preschoolers who cannot communicate effectively may have difficulty playing with other children and may become frustrated when they are unable to make their needs known.

Uncorrected, these problems can lead to learning difficulties and school failure, social ostracism, poor self-image, anxiety disorders and behavioral problems.

The authors of ''The Late Talker'' point out that ''speech and language disorders are the No.1 developmental impairment in children under the age of 5.'' They offer age-appropriate guidelines to help parents detect early warning signs of serious communication gaps and urge parents to act if they find reason for concern.

For referrals to qualified professionals, contact the American Speech-Language-Hearing Association at 10801 Rockville Pike, Rockville, Md. 20852, (301)897-5700 or (800)638-8255.

If 'Spaghetti' Is 'Psketti,' Should You Worry?

The authors of ''The Late Talker'' list behavior that can be early warning signs of possible serious communication problems:

Toddlers who have little sound play as infants, who produce a limited number of consonants and make vowel errors.

Toddlers who do not try to imitate word combinations when prompted or fail to use gestures to complement their communicative efforts.

Children who do not show a vocabulary spurt by 30 months.

Children who at 33 months use a limited number of all-purpose verbs -- want, go, get, do, make -- as in ''Me make water down.''

Three-year-olds who often omit consonants at the beginning and end of words, or who substitute consonants most often found at the end of words for front ones, as in ''gun'' for ''done.''

Four-year-olds with weak grammar, as in ''Her goed home.''

Children who are unable to repeat nonsense words of two or more syllables. Jane E. Brody

Drawing (Drawing by Sara Schwartz)

Correction: June 18, 2004, Friday The Personal Health column in Science Times on June 8, about speech disorders in young children, included one condition erroneously in a list of possible causes. As the article said, the causes can include an undetected hearing impairment; poor oral muscle tone or coordination; and apraxia, a breakdown in the transmission of messages from brain to mouth. They are not thought to include Asperger's syndrome, a neurological disorder.